1. A Clinical profile of patients enrolled in the Pakistan ACS registry
Sadia Arshad, Javed M Tai, Khawar A Kazmi Cardiology section,
Medicine department
Aga Khan University Hospital Karachi
4/14/2018
Department of Medicine

2. Timely and correct diagnosis has clinical and prognostic implications
Background:
Acute coronary syndrome is a clinical syndrome secondary to myocardial ischemia , categorized according to the clinical presentation of patients as unstable angina and myocardial infarction.
Timely and correct diagnosis has clinical and prognostic implications
Objectives:
To assess the clinical characteristics , treatment given, revascularization strategy and outcomes of patients admitted to three tertiary care centers with the diagnosis of acute coronary syndrome
4/14/2018
Department of Medicine

3. Methodology
This was a descriptive study conducted from March 2008 to December 2010 in the cardiology departments of three centers ; the Aga Khan University Hospital, Tabba Heart Institute, and Civil Hospital Karachi.
Patients were prospectively enrolled from the emergency departments of all three centers and screened for eligibility. The patients were followed till death or discharge from the hospital for outcome data.
4/14/2018
Department of Medicine

4. Students T test was used to compare means for quantitative data.
Pearsons Chi square was used to compare differences in categorical data between groups.
Anova was used to compare differences in means between the three groups.
P values <0.05 were considered significant.
4/14/2018
Department of Medicine

5. Results 1430 patients enrolled(AKU=397 THI=692 CHK=341)
Mean age was 63.7±18 years.
Strong male preponderance (75%)
Diabetes(35%) hypertension(47%) current or ex smokers
(42% )
4/14/2018
Department of Medicine

6. Majority of patients had a diagnosis of myocardial infarction (73%)
Shortest time to presentation was at CHK (mean time to arrival was 2.6 ±3.83 hrs vs THI (6.84± 5.8) AKU ( 6.65±8.2 hours)
Majority of patients had a diagnosis of myocardial infarction (73%)
We found a higher than expected percentage of ST elevation in the patients with MI (66%), mostly anterior.
4/14/2018
Department of Medicine

7. 33% received thrombolytics.
Primary PCI was performed in 42% and rescue PCI in 3.3%
Patients were mostly treated according to the guidelines
Mean LVEF was 48.2±17%.  
4/14/2018
Department of Medicine

8. Revascularization strategy N (%) P value AKU THI CHK
AKU
THI
CHK
Thrombolysis
8/231 (3.4)
131 (32.3)
96/149(64)
<0.05
Eligible for but not considered for thrombolysis
Late presentation
Contraindications
14(6.0)
51 (22)
61 (15)
10(2.5)
35 (23.4)
6 (4.0)
In-hospital coronary angiogram
277 (69.8)
561 (81.1)
101(29.5)
PCI
220 (55.4)
309 (44.6)
48(14)
Primary PCI
Rescue PCI
150 (37.8)
4.0 (1)
127(31.3)
17/ (4.1)
22 (14.7)
2(1.34)
CABG
43 (10.8)
46 (6.6)
2(0.6)
 In Hospital complications
N (%)  P
AKU
THI
CHK
Death
11 (2.8)
18(2.6)
5(1.5) NS
Re-infarction
1 (0.3)
1(0.1)
1(0.3)
Ventricular tachyarrythmias/SCD
10 (2.5)
3(0.4)
10(3)
CVA
2 (0.5)
11(1.6)
3(0.9)
Cardiogenic shock
14 (3.5)
2(0.3)
Pulmonary embolism
1(0.2)
3 (0.4)
2(0.5)
Major bleed requiring transfusion
4(1.0)
4/14/2018
, Department of Medicine

9. Conclusion
Patients with ACS in this study were predominately male , had a higher proportion of MI, (especially STEMI) and underwent catheter based intervention more than expected in this series. Mortality was lower than expected.
4/14/2018
Department of Medicine

10. Strengths/limitations
This study was done in public and private sector hospitals to ensure that patients from all areas and SES in Karachi would be able to be enrolled.
Selection bias
Data collection issues
Needs to be done all over the country in all communities.
4/14/2018
Department of Medicine

11. 4/14/2018
Research Day 2013, Department of Medicine